What ' s known on the subject? and What does the study add? Male genital lichen sclerosis is a disease of unknown aetiology which is believed to be a risk factor for penile cancer.This study reports that the disease can develop in non-genital skin grafts used for reconstruction following penile cancer surgery. OBJECTIVE• To describe the incidence of the development of male genital lichen sclerosus (LS) in non-genital skin grafts used in penile reconstruction after cancer surgery.
PATIENTS AND METHODS• Between 1997 and 2009, 177 patients received surgical treatment for penile cancer in the Urology Department at Sunderland Royal Hospital, the regional penile cancer centre for the north-east of England.• Patients who had organ-sparing surgery and non-genital penile graft reconstructions were identifi ed.• Histology reports for specimens obtained from those grafts were reviewed to identify the presence of male genital LS and the incidence of recurrence of squamous cell carcinoma (SCC).
RESULTS• The mean (range) age of patients at diagnosis was 61.8 (32 -89) years. Of the 177 patients, 139 had SCC, 32 had carcinoma in situ and six had verrucous carcinoma.• In total, 56 penile reconstructive procedures were performed using split-thickness skin grafts obtained from the inner thigh.• From those grafts, 18 specimens were obtained later for cosmetic, diagnostic or curative purposes.• Male genital LS was found in six of the 18 specimens, and one of them was associated with recurrent verrucous carcinoma.
CONCLUSIONS• This is the fi rst published series to describe the incidence of male genital LS in penile skin grafts taken from a remote site after penile cancer surgery.• These results represent new information that might help explain the aetiology of male genital LS.
KEYWORDS
The management of penile SCC in the UK has been centralised into SRNs covering populations >4 million. Whilst metastatic disease has a poor prognosis, IL can be curative in approximately half of these cases. We report a 5 year retrospective case series of patients undergoing IL as per European Association of Urology (EAU) guidelines from such a network since the rationalisation of services in 2005.Patients and methods: Retrospective case note analysis was undertaken of all patients who underwent IL following referral from the network units across a wide region. Information was crossreferenced from clinician, pathology and hospital episode databases.Results: 79 Modified ILs and 11 radical ILs were performed in 49 patients. Metastatic involvement was found in 57% of cases. 84% had primary tumours ≥pT2, and 94% were ≥G2. 90% of patients with nodal metastases but no extranodal spread survived disease free (median follow-up 48 months, range 7-96) compared with 65% with inguinal extranodal spread (median follow-up 22 months, range 4-48). As in most series, IL has a not inconsiderable morbidity rate. No perioperative mortality was seen.
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